TransCare says Hillsborough limits ambulance competition

TAMPA — The Hillsborough County agency that regulates cars for hire is once again facing accusations that instead of protecting the public welfare, it is preserving a monopoly for transport businesses.

Operators of TransCare Medical Transportation Services say they effectively have been shut out from offering a full suite of ambulance services due to the stranglehold two other companies have on Hillsborough County.

For the second time in three years, TransCare has applied to end restrictions put on its service by the Hillsborough County Public Transportation Commission. Those restrictions limit the company to responding to non-emergency 911 medical calls and transporting patients with mental health issues from one place to another.

TransCare wants to use its 19 permitted ambulances to transport all patients, not just those with psychiatric issues, between medical or treatment centers. As with previous attempts, the application is meeting vigorous opposition from the other ambulance businesses.

Those companies, American Medical Response (AMR) and AmeriCare Ambulance Service, have successfully killed TransCare's prior efforts to expand. A TransCare attorney argues the regulatory system is set up to preserve the status quo rather than determine whether there is an actual need for additional service.

"It has become a system geared to protect the duopoly. That's it," said Steve Anderson. "That's turning the system on its head and forgetting what you're there for."

Question of need

Representatives of the other companies say TransCare has failed to show there is a need for more ambulances. They say there isn't.

Further, they say the setup, in which TransCare provides backup service on county 911 calls and transport service, is the very arrangement the company agreed to take on many years ago and is now trying to void.

"We have a model that's working perfectly," said David Carr, the former Tampa City Council attorney who is part owner of AmeriCare. "The only problem is the backup is trying to become a primary provider."

In Hillsborough, city of Tampa and county fire-rescue workers respond to true emergency calls such as those from people suffering from a possible heart or asthma attack. The local governments have agreements with private providers to respond to 911 calls from people with nonlife-threatening injuries, such as a broken foot.

TransCare is the first responder to non-emergency calls in the Tampa, while AmeriCare and AMR get the calls first outside city limits, with TransCare providing backup service if they're not available. If none of the companies can take the call, more highly trained city and county fire-rescue paramedics respond.

Those so-called basic life support calls are not particularly lucrative. They are canceled more often than not. Many callers are uninsured or rely on Medicaid or Medicare, whose payments for ambulance transport are not keeping up with costs.

So the companies are allowed to compete for more lucrative work: transporting patients between nursing homes, hospitals or diagnostic clinics.

However, under agreements dating to 1996, TransCare, a subsidiary of the nonprofit Crisis Center of Tampa Bay, is limited to transporting only patients with mental health issues, responding as a backup if the other companies aren't available for other transports.

The Crisis Center helps people dealing with mental health issues, including those considering suicide, which is how it started out transporting those kinds of patients. Charges for the service helps subsidize the Crisis Center.

Increasingly, however, to maintain even that ability TransCare is shouldering an increasing number of 911 calls while the other companies answer fewer, according to state statistics. So TransCare once again is trying to have the restriction from transporting other patients lifted.

"We really can't grow any more to meet that need without something else," said Terence Ramotar, vice president for TransCare.

TransCare entering the market should lead to more competitive pricing, the company argues. That will enable it to continue handling non-emergency calls, keeping city and county paramedics available for emergency response.

An unfair edge?

The PTC regulates cars for hire, including ambulance, taxis, limousines and tow-truck operators. In each of those arenas, it regularly faces accusations from people looking to get into the business or from smaller companies that its rules and permitting processes favor larger companies.

The agency, consisting of elected officials from the county and its three cities, is the entity that considers applications, certifying companies have the ability to do the work. It issues certificates to the ambulance companies to provide basic life support service and considers applications for how many vehicles they can operate.

In considering applications for new or expanded service, the PTC weighs whether new ambulances would provide a "public convenience and necessity" In other words, are more needed?

Typically, the PTC relies on a hearing officer to make a recommendation.

Multiple times previously, a hearing officer and the PTC have ruled against TransCare. The most recent time, TransCare says, the hearing officer used curious rationale. He said TransCare would have an unfair advantage over the other companies.

At the time, TransCare was receiving county money to transport people who are involuntarily committed for mental health treatment under the state's Baker Act. That county support gave TransCare an unfair edge over the other two companies, the hearing officer found.

TransCare still provides the service, but only after competing through a bid process against the other companies. It also is now paid per call rather than receiving a blanket amount. Anderson said that, while he doesn't believe the county grant money was a valid consideration, the issue should be moot now.

"That issue, as far as we're concerned, should be totally off the table," he said.

Before and after the 2010 hearing, the PTC granted additional ambulance permits to AmeriCare, finding there was a need.

Before a preliminary hearing last week for the new applications, attorneys for the two other ambulance firms intimated they believe TransCare still has an unfair edge. It operates as a not-for-profit company and still receives federal tax money for services the Crisis Center provides. Further, an AMR attorney argued, it has a separate agreement with TransCare from the first time it sought to get into the broader transport business in 1996 in which the company pledged not to seek that work. The attorney, Seth Mills, said he will seek financial damages if TransCare pursues its application.

"TransCare signed a written contract agreeing to limit its certificate to only doing psychiatric transports," Mills said. "They are now trying to fundamentally change that understanding in breach of the contract. Our position is that TransCare agreed to this limitation and can't unilaterally change it."